title: Decreasing incidence and severity of cerebral palsy in prematurely born children.
abstract: OBJECTIVE
  To examine incidence and severity of cerebral palsy (CP), and associated factors among preterm survivors (gestational age <34 weeks), admitted to a neonatal intensive care unit from 1990-2005.
  
  
  METHODS
  Eighteen antenatal, perinatal and postnatal factors were analyzed. The cohort was divided in four birth periods: 1990-1993 (n=661), 1994-1997 (n=726), 1998-2001 (n=723), and 2002-2005 (n=850). The Gross Motor Function Classification System was used as primary outcome measure (mean age: 32.9 ± 5.3 months). Logistic regression analyses were used.
  
  
  RESULTS
  CP incidence decreased from 6.5% in period I, to 2.6%, 2.9% and 2.2% (P<.001) in period II-IV, respectively. Simultaneously, cystic periventricular leukomalacia (c-PVL) decreased from 3.3% in period I to 1.3% in period IV (P=.004). Within the total cohort (n=3287), c-PVL grade III decreased from 2.3% in period I to 0.2% in period IV (P=.003). The number of children with Gross Motor Function Classification System levels III-V decreased from period I to IV (P=.035). Independent risk factors for CP were c-PVL and severe intraventricular hemorrhage, whereas antenatal antibiotics, presence of an arterial line, Caesarean section, and gestational age were independent protective factors.
  
  
  CONCLUSIONS
  CP incidence and severity decreased from 1990-1993 onward, which could be attributed to a reduction of 93% in severe c-PVL.
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Ingrid C
authors.initials: IC
authors.lastname: van Haastert
authors.forename: Floris
authors.initials: F
authors.lastname: Groenendaal
authors.forename: Cuno S P M
authors.initials: CS
authors.lastname: Uiterwaal
authors.forename: Jacqueline U M
authors.initials: JU
authors.lastname: Termote
authors.forename: Marja
authors.initials: M
authors.lastname: van der Heide-Jalving
authors.forename: Maria J C
authors.initials: MJ
authors.lastname: Eijsermans
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Gorter
authors.forename: Paul J M
authors.initials: PJ
authors.lastname: Helders
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Jongmans
authors.forename: Linda S
authors.initials: LS
authors.lastname: de Vries
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001724:Birth Weight; D002408:Catheters, Indwelling; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002547:Cerebral Palsy / Q000145:classification / Q000453:epidemiology*; D002585:Cesarean Section; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007969:Leukomalacia, Periventricular / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D011295:Prenatal Care; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents